Healthcare Provider Details

I. General information

NPI: 1568798551
Provider Name (Legal Business Name): REGATA MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 RIVERSIDE DR
TOLUCA LAKE CA
91602-2371
US

IV. Provider business mailing address

10745 RIVERSIDE DR
TOLUCA LAKE CA
91602-2371
US

V. Phone/Fax

Practice location:
  • Phone: 818-623-0197
  • Fax: 818-623-8933
Mailing address:
  • Phone: 818-623-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number110793
License Number StateCA

VIII. Authorized Official

Name: MS. SONA AVEDISYAN
Title or Position: CEO
Credential:
Phone: 18189948200